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Eur Heart J Acute Cardiovasc Care. 2017 Oct;6(7):610-622. doi: 10.1177/2048872616661847. Epub 2016 Aug 2.

Editor's Choice-Sex differences in young patients with acute myocardial infarction: A VIRGO study analysis.

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1 Yale School of Medicine, New Haven, CT, USA.
2 Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
3 Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
4 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA.
5 Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
6 Department of Obstetrics and Gynecology Program in Integrative Sexual Medicine, Department of Medicine - Geriatrics, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA.
7 Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.
8 Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
9 Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Australia.
10 Centro Nacional de Investigaciones Cardiovasculares, Instituto de Investigacion i+12, Cardiology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain.
11 Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
12 Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.



Young women with acute myocardial infarction (AMI) have a higher risk of adverse outcomes than men. However, it is unclear how young women with AMI are different from young men across a spectrum of characteristics. We sought to compare young women and men at the time of AMI on six domains of demographic and clinical factors in order to determine whether they have distinct profiles.


Using data from Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO), a prospective cohort study of women and men aged ⩽55 years hospitalized for AMI ( n = 3501) in the United States and Spain, we evaluated sex differences in demographics, healthcare access, cardiovascular risk and psychosocial factors, symptoms and pre-hospital delay, clinical presentation, and hospital management for AMI. The study sample included 2349 (67%) women and 1152 (33%) men with a mean age of 47 years. Young women with AMI had higher rates of cardiovascular risk factors and comorbidities than men, including diabetes, congestive heart failure, chronic obstructive pulmonary disease, renal failure, and morbid obesity. They also exhibited higher levels of depression and stress, poorer physical and mental health status, and lower quality of life at baseline. Women had more delays in presentation and presented with higher clinical risk scores on average than men; however, men presented with higher levels of cardiac biomarkers and more classic electrocardiogram findings. Women were less likely to undergo revascularization procedures during hospitalization, and women with ST segment elevation myocardial infarction were less likely to receive timely primary reperfusion.


Young women with AMI represent a distinct, higher-risk population that is different from young men.


Myocardial infarction; epidemiology; prognosis; risk factors; sex

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